Dilaudid Question

Luv cats · Oct 27, 2002

We give 1-2 mg IVP. I usually dilute that. We have one Dr. that always wants it given per syringe pump.

Y2KRN · Oct 27, 2002

Thank you all for your input, this was a patient who had a tolerance due to chronic non-cancer pain. I did give her two doses of Dilaudid 6mg at a time. When she asked for her third dose, I was a little leary and told the Doctor I did not feel comfortable to give her another dose so soon. I must enforce that I am not stingy with pain medication, it was just a feeling I had that we might go over the threshold if we gave her one more dose of 6mg. I asked the Doc to go and speak with her and also told her my concern for giving one more dose of the Dilaudid.

The Doc came back and told me that he could only talk her down to 4 mg of dilaudid. Well I gave the it and her sats and resp. decreased fast!! I just had that feeling you know?? She was fine after 12mg. Four more pushed her over the edge and we ended up keeping her in the ER another two hours after narcan to turn her sats around.

Some of my co-workers were like always make yourself a limit to how much pain medication you would give. I don't think I could do that, all pain is subjective. It is nice to see the reinforcement of that attitude projected here.

I felt bad because we had to give her narcan, but she did get to to home!

Again thank you all for your input. I guess I will just have to trust my instincts more, that is hard to do sometimes.

Y2KRN

P_RN, ADN, RN · Oct 28, 2002

10 mg IVP q 2h to sickle cell patients in crisis.

duckie · Oct 28, 2002

I have never given it but I did receive it twice while passing kidney stones. 0.5 IV push and I was floating with the Angels, happy as a clam. WOW, that stuff kicks butt when you are in mega pain. Glad to say, it relaxed me enough to pass the stone both times and what a buzz I had. Within a split second my B/P went from 260/170 to normal. My husband said it looked like someone put an instant glaze over my eyes. That's one very powerful drug!!!!!!!

Andy S., BSN, RN · Oct 28, 2002

I gave 12mg in one hour (2 does of 6mg) to a sickle cell crisis patient. I believe some patients are more tolerant to drugs; especially those on narcotics for chronice pain issues. I once gave a terminal cancer patient MS Contin 2,000mg P.O. BID. He had a hx of chronic back pain before the cancer and had built up a huge tolerance to the medication. He had been on a MS drip prior and we were attempting to send him home on oral meds. I gave it to him, counted it out about twenty times. The pharmacist call me just to make sure he had read it correctly. I had already verified it with the Doctor in person. The patient acted a little groggy, but still breathing/walking/talking. Weird

kids · Oct 29, 2002

I had a female 40ish end stage lung ca patient on a continuous MS drip at 750 mg/hr before she died. She had a peripheral site and NO veins left...we would pray the site would out last her several times a shift.

rgroyer1RNBSN, BSN, RN · Jan 29, 2008

I had 12 Mg IV-p myself for my crohns, when I had a bad bleed and had to have an exploratory lap.

angel4gramma · Jan 30, 2008

Typical dose is 2 mg q 4 hrs but we have frequent flyers that come in for 8 mg q 2-4 hours or 2 mg q hour. The issue I have is the pain scale never changes. Pain is always an 8-10/10.I have chronic pain and take ultram once in a while. Pts feel they should never have any pain. I would feel better if their pain decreased after I gave it to them.

Nightcrawler, BSN, RN · Jan 30, 2008

We have a lady that has major chronic pain issues, and the docs are trying to start titrating her pca down so the she can go home. At her max she was receiving 8mg Dilaudid as a basal rate, with 4mg demand doses every 15 minutes. She could also have Actiq (Fentanyl lollypops), two at a time, muscle relaxants, and 100mg of Phenergan IV per dose.

One of the scariest things was that this is a dialysis patient, so she will not clear the meds in a normal fashion

rnmi2004 · Jan 30, 2008

12mg IVpush Q 2 hours. :uhoh21: Pt was recovering from injuries sustained in a drug deal gone bad.

TiredMD · Jan 30, 2008

Typical dose is 2 mg q 4 hrs but we have frequent flyers that come in for 8 mg q 2-4 hours or 2 mg q hour.

That's a fairly hefty dose, and I certainly wouldn't recommend starting that on an opiate-naive patient. Dilaudid is generally converted 10:1 to morphine IV, so you're talking about the equivalent of 20mg of morphine there. I will generally start at 0.2mg IVP in most patients.

That being said. I have seen 20mg+ pushed on a patient over a two hour period.

angel4gramma · Feb 1, 2008

That's a fairly hefty dose, and I certainly wouldn't recommend starting that on an opiate-naive patient. Dilaudid is generally converted 10:1 to morphine IV, so you're talking about the equivalent of 20mg of morphine there. I will generally start at 0.2mg IVP in most patients.
That being said. I have seen 20mg+ pushed on a patient over a two hour period.

I know thats a big dose, that is what is normally ordered by the MD. They are usually frequent flyers who come in knowing if they complain enough that is what they will give. Some of the pt fall asleep before I can get back in the room with the drug so I leave until they call again. They are upset I didnt just give it. If they cant stay awake while I go through the process of getting the med to their room they really dont need it. I have seen 0.5mg dose 10% of the time. 75% they order 2 mg at a time. I guess they dont like being woken up asking for more meds.